Embedding implants in undergraduate dental education

Awareness of peri-implantitis among general dental practitioners in the UK: a questionnaire study

Introduction Dental implants are a predictable prosthetic option for replacement of missing teeth with good survival rates. Peri-implant diseases are the main reason for implant failure by causing bone loss around the implant leading to implant loss. General dental practitioners see patients with dental implants routinely and therefore, awareness of risk factors for peri-implant disease and early diagnosis is essential for appropriate management. The aim of this study is to assess the awareness of general dental practitioners in diagnosing peri-implantitis, with a view to identify any potential training needs.Design, setting, materials and methods A quantitative study method was designed using an online questionnaire sent to closed social media groups in the UK. The significance level was taken as p <0.05. The chi-squared tests and Kruskal-Wallis tests were used with IBM SPSS software. Descriptive statistical analysis of data was also done.Results and conclusion A total of 224 responses were received. The results show that there is lack of awareness of diagnostic criteria of peri-implantitis among general dental practitioners. However, majority of practitioners are aware of the legal implications of failing to diagnose this condition. There is a perceived need for more undergraduate training in diagnosing peri-implant diseases.

Current Undergraduate Dental Implantology Teaching in UK

Dental Implants are a popular treatment option for tooth replacement, with documented long-term success and survival rates of more than 95% over a period of 10 years. However, incorporating dental implantology into an undergraduate dental curriculum has issues associated. Therefore, the aim of this research was to examine and evaluate current undergraduate dental implantology education in the UK, investigate the amount of time allocated to this subject and analyse the barriers that are currently impeding the development of the programmes. An online questionnaire hosted by Online Surveys was designed, piloted, and sent to 16 dental schools providing undergraduate education in the UK. Ethical approval was gained from The University of Salford to conduct the study. Out of the 16 dental schools contacted, eight questionnaire responses were received, hence a response rate of 50% was achieved. The hours dedicated to the implant teaching programme varied from 3 h to 25 h, with a mean average of 11 h. It was identified from the results that no teaching of dental implantology was conducted in year 2; 12% of the schools responded that the subject was taught in year 1, 37% in year 3, 75% in year 4 and 50% in year 5. The methods used to deliver the programme were mainly lecture-based teaching, with only one dental school allowing students to place implants on patients. The main barriers to progression of the programme were financial (75%), followed by time limitations imposed by the curriculum (37%) and liability insurance (37%). However, there appears to be a consensus that further training beyond bachelor’s degree level is required to teach implantology effectively.

Predoctoral dental implant education techniques-students' perception and attitude

PURPOSE

Dental implant (DI) therapy is in high demand and can only be rendered efficiently to graduating dentists by effective teaching methodologies. This study aimed to assess the perceptions and attitudes of dental graduates towards predoctoral DI education techniques and rehabilitation by DI.

METHODS

A total of 26 well-structured questionnaires were distributed to 120 final-year students. Modified advanced teaching methodologies such as e-learning, small-group teaching-problem-based learning (SGT-PBL), and team-based learning were implemented for teaching DI. Its effects were assessed using a questionnaire set: the first section (DI Rehabilitation) with 12 questions and the second (DI teaching methods) with 14 questions. Statistical analysis was done using the Chi-square test, and a P-value < 0.05 was considered statistically significant.

RESULTS

The response rate was 95.83%. Seventy-five percent of the students recommended DI for patients, and 78% of them agreed to it themselves. On comparing teaching methods for DI, on and before level 12, small-group teaching (PBL) was significantly at a higher proportion (P = 0.002), followed by seminars (P < 0.001). Students preferred small-group teaching PBL (60%), followed by e-learning (15%) and demonstration (10%). Ninety-two percent of the students agreed that DI is an important subject in the "bachelor of dental surgery" (BDS) program, but 78% of them felt that time was insufficient to complete the DI syllabus.

CONCLUSIONS

The modified teaching methodologies used at level 12 for teaching DI enhanced students' interest and knowledge. The SGT-PBL teaching method was the most preferred. It is recommended that dental implantology topics should be started early in the undergraduate curriculum, and the topics should be widely divided throughout BDS.

Teaching of dental implantology to undergraduate dental students: The Nigerian experience

INTRODUCTION

Dental implantology is an increasingly contemporary integral and important component of the practice of dentistry. This study assessed the level of teaching of dental implantology to dental undergraduates in Nigeria.

MATERIALS AND METHODS

This was a cross-sectional descriptive study involving the use of a self-administered questionnaire consisting of five sections developed for this study. It was sent via e-mail to a dental faculty in charge of and involved in the teaching of dental implantology in all 10 dental schools (five old generation and five new generation) in Nigeria.

RESULTS

Eight of the 10 schools teach implant dentistry and utilised didactic lectures as mode of teaching. Simulations were used in only 1 (12.5%) of the schools whilst clinical demonstration was reported by 2 (25.0%) of the schools. Only 2 (25.0%) of the schools allowed students to experience direct patient care with no school expecting students to provide implant treatment. Almost all schools 9 (90.0%) identified insufficient resources and lack of dental industry support as barriers to effective teaching of implant dentistry. All the dental schools had plans to improve teaching of implant dentistry.

CONCLUSION

Teaching of dental implantology in Nigeria is mainly theoretical with no clinical competence assigned. A situation which is unsatisfactory as all Nigerian dental schools have plans both in the short term and long term to improve on the teaching of implant dentistry. There is need for industry support as well as improved and effective training of dental faculty in implant dentistry in Nigeria.

A cross-sectional survey of attitudes towards education in implant dentistry in the undergraduate dental curriculum

BACKGROUND

An ongoing debate in dental education is whether implant dentistry, as a multidisciplinary domain, should be integrated into the undergraduate curriculum. The aim of the present study was to evaluate the perspectives of novices, clinical educators, and experienced dentists with regard to the importance of theoretical and practical implant dentistry teaching content in undergraduate dental education. The specific objective was to determine whether a consensus could be found concerning aspects of theoretical knowledge, implant position planning, implantation, prosthetic treatment procedures, postoperative care, and prerequisite experiences that should be provided in undergraduate dental education.

RESULTS

A positive consensus existed in terms of theoretical education, assistance in surgical and prosthodontic procedures, implant planning and restoration in straightforward cases (i.e., posterior single crowns and bridges, overdentures on nonconnected implants), and postoperative care. A negative consensus existed for bone augmentation. Implantation was supported by novices (i.e., students and graduates). In addition, more experienced dentists were more likely to oppose implantation performed by undergraduates. The most preferred implantation method was implant insertion using a digitally fabricated drilling template, after surgical flap elevation.

CONCLUSIONS

Students and graduates preferred a comprehensive undergraduate education that included implant dentistry. Dentists working in private practice, and especially dentists working as university educators, were critical towards the integration of implant-related learning content into undergraduate education. The intention of medical education is to impart knowledge to students and to prepare them for life-long learning and continual professional development after graduation. Thus, an undergraduate dental curriculum that provides students a solid introduction and knowledge foundation in implant dentistry is recommended.

Are UK graduates equipped with the skill set required to meet the demands of the UK's edentulous population?

As the UK witnesses a decline in the number of edentulous adults, there is a simultaneous reduction in the number of cases available to undergraduate dental students for the teaching of complete dentures. When edentulous adults are unable to function with conventional complete dentures, particularly pertaining to the mandibular denture, an implant-supported mandibular overdenture has been evidenced as the gold standard for edentulous patients. The evidence in favour of mandibular implant-supported overdentures is one of the most robust evidence bases for any clinical treatment and similarly it has been shown that undergraduate students are equally as capable in the provision of implant-supported overdentures as experienced prosthodontists. Yet there appears to be a disparity in the General Dental Council's undergraduate learning outcomes pertaining to care for edentulous adults. Furthermore, the UK seems to be falling behind in this respect in comparison to our European, American and Australian colleagues. This review looks at the evidence for the provision of implant-supported overdentures in the setting of the undergraduate dental curriculum, the potential barriers within this teaching forum and how well prepared UK undergraduates are for the clinical management of edentulous patients in the future.

Oral implant placement and restoration by undergraduate students: clinical outcomes and student perceptions

INTRODUCTION

Universities are developing and implementing implant dentistry training to prepare dental professionals for the growing treatment needs. This study describes how implant dentistry is taught at the KU Leuven and focuses on implant-related clinical outcomes. Perspectives of participating undergraduate students are analysed with a view to improve oral implant dentistry training.

MATERIALS AND METHODS

Implant dentistry training at the KU Leuven consists of theoretical lectures, pre-clinical hands-on workshops and clinical (surgical/prosthetic) experience. Questionnaires were used to investigate the perceptions of students on the educational programme. Radiographs were taken at implant insertion, at healing abutment connection, at restoration/prosthesis insertion and after 1 and 2 years of functional loading. The marginal bone level was measured from the implant-abutment connection to the first visible bone-to-implant contact.

RESULTS

One hundred and twelve implants were placed by 56 undergraduate students (61.5% of the total students) in 56 patients. After a follow-up time of 3 years, the cumulative implant survival rate, at implant level, was 97.1%. The mean marginal bone loss after 1 and 2 years in function was 0.35 mm and 0.39 mm, respectively. Eighty percentage of students were satisfied with the training, and they considered this sufficient preparation to perform implant placement under close supervision.

CONCLUSIONS

The clinical outcome of implant treatment performed by undergraduate students under close supervision is similar to that reported by experienced clinicians/research teams. Clinical, surgical as well as restorative experience in addition to theoretical and pre-clinical training seems beneficial when implementing implant dentistry in the undergraduate programmes.

Dental implants placed by undergraduate students: clinical outcomes and patients'/students' perceptions

INTRODUCTION

Implant dentistry in undergraduate education is predominantly theoretical or prosthetics oriented. Clinical experience with implant surgery could provide students a better understanding of alternatives for tooth replacements. This study describes an implant dentistry programme for undergraduate students, which included surgical placement of implants. The study presents the clinical outcomes of the programme, patients' satisfaction and students' attitudes/perceptions. It reflects on barriers and problems encountered during implementation and provides suggestions for other institutions.

MATERIALS AND METHODS

Thirty-six students placed one implant each for a single tooth replacement after careful radiographic assessment and pre-surgical planning. One-stage surgery was performed under one-to-one supervision. Crowns were cemented on individual abutments 3-6 months later. Crestal bone loss was assessed radiographically immediately after surgery, at crown placement and after 1 year of loading. Questionnaires were used to investigate patients' perspectives and students' opinions towards the programme, as well as their perceived level of competence.

RESULTS

Thirty-six implants were placed in 27 patients; two (5.6%) failed prior to loading; mean bone loss from time of surgery to crown placement was 1.41 mm and remained unchanged thereafter, reflecting implant success. Overall, patients were satisfied and the majority would repeat the treatment by a student. The students thought it was a valuable experience, although they realised that additional education is necessary to perform implant surgery without supervision.

CONCLUSION

Implant placement by undergraduate students resulted in acceptable clinical outcome parameters, patient satisfaction and positive student perceptions. These findings support the further development of clinical implant education in undergraduate dental curricula.

Developing implant dentistry education in Europe: the continuum from undergraduate to postgraduate education and continuing professional development

INTRODUCTION

Implant dentistry is a treatment modality which has mainstream clinical practice of comprehensive care, which however is not adequately represented in the undergraduate dental curricula. A consensus workshop organised by ADEE in 2008, set the benchmarks for the knowledge and competences a modern dental practitioner must possess with regard to implant dentistry, as well as defined undergraduate and postgraduate pathways for the acquisition of these competences. Today, 5 years later, there exist several challenges for the implementation of these benchmarks in both undergraduate curricula but also post-graduation educational pathways.

METHODS

A consensus workshop was organised by ADEE, bringing together 48 opinion leaders, including academic teachers of all disciplines related to implant dentistry, specialists, representatives of relevant scientific and professional associations, as well as industry delegates. The objectives of the workshop were to evaluate the existing scientific literature, reported experience and best practices in order to identify potential and limitations for the implementation of implant dentistry in the undergraduate curriculum, as well produce recommendations for the optimal educational structures for postgraduate programmes and continuing professional development.

RESULTS

The scientific committee conducted two European-wide questionnaire surveys to better document the current state of education in implant dentistry. Upon completion of the surveys, reviewers were appointed to produce three scientific review papers, identifying current achievements and future challenges. Finally, during the 3 days of the workshop, all the evidence was reviewed and the main conclusions and recommendations that were adopted by all participants are reported in the present Consensus Paper.

CONCLUSIONS

Implementation of implant dentistry in the undergraduate curriculum has improved significantly, but still lags behind the benchmarks set in 2008 and the diversity between institutions remains big. At the post-graduation level, there is currently a wide diversity of courses and pathways towards competences related to implant dentistry and there is at present a great need for quality assurance, as well as standardisation and transparency of the learning outcomes.

Implant dentistry education in Europe: 5 years after the Association for Dental Education in Europe consensus report

INTRODUCTION

To promote consensus on implant dentistry university education in Europe, a workshop amongst university teachers and opinion leaders was organised in 2008. As a result, guidelines on both under- and postgraduate education were issued. This study aims to investigate the current status of university teaching of implant dentistry and the impact of the recommendations for teaching and assessment, 5 years after the first consensus. Finally, this report attempts to identify future directions in education within the discipline.

MATERIALS AND METHODS

An online survey was distributed amongst 105 academic leaders in implant education in Europe, and 52 questionnaires were returned (response rate 50%).

RESULTS

The average amount of implant dentistry in undergraduate curricula has increased to 74 h, compared to 36 h in 2008, and the inclusion of pre-clinical and clinical education has increased. No change occurred with regard to the aimed competence levels. It was suggested that certain implant procedures including surgery should be provided by dentists after attending additional courses, whilst complex treatments will still require specialist training. The 2008 workshop guidelines have been implemented to a varying extent (25-100%) in under- and postgraduate education. Main reported implementation barriers included limited time availability in the curriculum and limited financial/material resources. Future discussions about implant dentistry in Europe should be focused towards integration in current dental curricula, approaches to overcome barriers and the relations with and role of industrial partners.

CONCLUSION

Implant dentistry is increasingly integrating in undergraduate dental education. Development of the consensus guidelines in 2008 may have facilitated this process. Nevertheless, further progress is needed on all educational levels to align training of professionals to the growing treatment needs of the population.

Contemporary undergraduate implant dentistry education: a systematic review

INTRODUCTION

Consensus reports recommend that students upon graduation should possess a significant level of knowledge and competence in implant dentistry, including basic competences in diagnostics, treatment planning, restorative, straightforward surgical and maintenance procedures. In response, undergraduate curricula need to integrate implant dentistry. This narrative review explores educational programmes in terms of competences, related research and barriers or reflections, regarding implementation in undergraduate curricula.

MATERIALS AND METHODS

Publications (2008-2013) were searched systematically in WoS, PubMed and ERIC and screened independently by two authors in four stages: removal of duplicates, title screening, abstract screening and full-text reading. Inclusion criteria encompassed implant dentistry in undergraduate education.

RESULTS

Finally, 37 of 420 papers were included. Detailed information regarding programme content, number of participants, staff input, logistics/funding issues is scattered. Theoretical education is predominant, and pre-clinical/clinical training is offered minimally, often carried out in elective programmes. However, selected straightforward cases treated by undergraduates yield positive outcomes with low failure rates, few complications, high patient satisfaction and student appreciation. Barriers to implementing implant dentistry in the undergraduate curriculum include funding issues, limitations in time or staff availability/competence and lack of suitable patients. Overcoming these barriers is worthwhile as experience-based implant education affects future practice as well-informed students propose more restorative alternatives to their patients.

CONCLUSION

Although implant dentistry is increasingly integrated in undergraduate curricula, challenges remain in developing strategies to implement existing competence profiles and the extent of experience-based education. To support further advancement, universities should report comprehensively on their implant programmes to allow comparison and reproduction in other environments.